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Vitamin A for the treatment of measles in children - A systematic review

Rennie M. D'Souza, and Ron D'Souza

Objective: To determine whether vitamin A prevents mortality and pneumonia specific mortality in children with measles.
Design: Meta-analysis of randomised controlled trials
Setting: A systematic search of the medical literature identified studies that used vitamin A to treat measles.
Subjects: 492 children aged 6 months to 13 years were supplemented with vitamin A and 536 with placebo in six trials, five of which were conducted in hospitals and one in the community.
Main outcome measures: Mortality and pneumonia specific mortality.
Results:
We found no evidence that a single dose of 200,000 IU of vitamin A was associated with reduced mortality among children with measles; relative risk was 1.25 (95% confidence interval 0.48 to 3.1; heterogeneity, P=0.60). The same dose given for two days was associated with a reduced risk of overall mortality 0.36; (0.14 to 0.82; heterogeneity, P=0.51) and pneumonia specific mortality 0.33 (0.08 to 0.92; heterogeneity, P=0.74) in hospitalised children in areas with high case fatality. The effect was greater in children under the age of two years 0.17 (0.03 to 0.61; heterogeneity, P=0.79). There were no trials comparing a single dose with two doses of vitamin A. There were not enough studies to separate out the individual effects of age, dose, formulation, hospitalisation and case fatality in the study area.
Conclusions:
200,000 IU of vitamin A repeated on two days should be used for the treatment of measles as recommended by WHO in children admitted to hospitals in areas where the case fatality is high.